Radiation system with rotating patient support

ABSTRACT

A patient support system includes a patient support having a surface for supporting a patient and a longitudinal axis, and a positioner coupled to the patient support for positioning the patient support, wherein the positioner is configured to move the patient support along a path that has an arc, circular, or zig-zag shape, and wherein the path lies within a plane that forms an angle with the surface of the patient support.

RELATED APPLICATION DATA

This application is a continuation of U.S. patent application Ser. No.12/830,310, filed on Jul. 3, 2010, pending, which is acontinuation-in-part of U.S. patent application Ser. No. 12/201,271,filed on Aug. 29, 2008, now issued as U.S. Pat. No. 7,773,723 which is acontinuation of U.S. patent application Ser. No. 12/200,639 filed onAug. 28, 2008,now issued as U.S. Pat. No. 7,835,494, the entiredisclosures of all of which are expressly incorporated by referenceherein.

FIELD

This application relates generally to treatment and diagnostic systems,and more specifically, to treatment systems and diagnostic systems thatinvolve a rotating beam source.

BACKGROUND

Radiation therapy has been employed to treat tumorous tissue. Inradiation therapy, a high energy beam is applied from an external sourcetowards the patient. The external source, which may be rotating (as inthe case for arc therapy), produces a collimated beam of radiation thatis directed into the patient to the target site. The dose and placementof the dose must be accurately controlled to ensure that the tumorreceives sufficient radiation, and that damage to the surroundinghealthy tissue is minimized.

Existing radiation machines for providing treatment radiation beam mayinclude a bore, into which the patient is placed during a treatmentprocedure. Other radiation machines may include an arm that carries theradiation source, wherein the patient is placed at an operative positionrelative to the source during a procedure. Similarly, existing imagingmachines, such as CT machines, for obtaining images of the patient alsoinclude a bore, into which the patient is placed during an imagingprocedure.

Applicants of the subject application determines that the bores ofexisting treatment and imaging machines may be too small, and that apatient may not feel comfortable when confined within the limited spaceof the bore of the treatment or imaging machine. Also, for treatment andimaging machines that do not include a bore, but include an arm forcarrying the radiation source, the configuration of the arm may belimiting in some situations. This is especially the case when thepatient is overweight, and/or when a treatment or imaging session takesa while to complete. If the distance between the patient and the sourceis too small, the patient may not feel comfortable. Thus, applicants ofthe subject application determine that it would be desirable to providea new patient support system for addressing the above problems.

SUMMARY

In accordance with some embodiments, a radiation system includes aradiation source, and a patient support for supporting a patient, thepatient support located at an operative position relative to theradiation source such that the radiation source can deliver radiationtowards the patient while the patient is supported on the patientsupport, wherein the patient support and the radiation source arepositionable at least partially around a same spatial region.

In accordance with other embodiments, a radiation method includesplacing a radiation source at a first gantry angle, delivering a firstbeam using the radiation source towards a target supported on a support,the first beam is delivered when the radiation source is at the firstgantry angle and when the support is located at a first position,placing the radiation source at a second gantry angle, positioning thesupport at least partially around a spatial region to move the supportfrom the first position to a second position, and delivering a secondbeam using the radiation source towards the target when the radiationsource is at the second gantry angle and when the support is at thesecond position.

In accordance with other embodiments, a patient support system includesa patient support having a surface for supporting a patient, the patientsupport having a longitudinal axis, and a positioner coupled to thepatient support for positioning the patient support, the positionerconfigured to rotate the patient support about an axis that is parallelto, and spaced away from, the longitudinal axis.

In accordance with other embodiments, a patient support system includesa patient support having a surface for supporting a patient and alongitudinal axis, and a positioner coupled to the patient support forpositioning the patient support, wherein the positioner is configured tomove the patient support along a path that has an arc, circular, orzig-zag shape, and wherein the path lies within a plane that forms anangle with the surface of the patient support.

Other and further aspects and features will be evident from reading thefollowing detailed description of the embodiments, which are intended toillustrate, not limit, the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

The drawings illustrate the design and utility of embodiments, in whichsimilar elements are referred to by common reference numerals. Thesedrawings are not necessarily drawn to scale. In order to betterappreciate how the above-recited and other advantages and objects areobtained, a more particular description of the embodiments will berendered, which are illustrated in the accompanying drawings. Thesedrawings depict only typical embodiments and are not therefore to beconsidered limiting of its scope.

FIG. 1 illustrates a system for delivering radiation in accordance witha treatment plan determined in accordance with embodiments describedherein;

FIGS. 2 and 3 illustrate a method of determining a treatment plan inaccordance with some embodiments;

FIG. 4 illustrates an example of a target region and three dosecalculation points;

FIG. 5 illustrates an example of a fluence map representing fluencegenerated using a collimator;

FIG. 6 illustrates an example of converting fluence map into leafsequencing;

FIG. 7 illustrates an example of converting fluence map into radiationsource positioning;

FIG. 8 illustrates a radiation system in accordance with otherembodiments;

FIG. 9 illustrates another radiation system in accordance with otherembodiments;

FIG. 10A illustrates a patient support system in accordance with someembodiments;

FIG. 10B illustrates another patient support system in accordance withother embodiments;

FIGS. 11A-11C illustrate examples of trajectories of a treatment plan;and

FIG. 12 is a block diagram of a computer system architecture, with whichembodiments described herein may be implemented.

DESCRIPTION OF THE EMBODIMENTS

Various embodiments are described hereinafter with reference to thefigures. It should be noted that the figures are not drawn to scale andthat elements of similar structures or functions are represented by likereference numerals throughout the figures. It should also be noted thatthe figures are only intended to facilitate the description of theembodiments. They are not intended as an exhaustive description of theinvention or as a limitation on the scope of the invention. In addition,an illustrated embodiment needs not have all the aspects or advantagesshown. An aspect or an advantage described in conjunction with aparticular embodiment is not necessarily limited to that embodiment andcan be practiced in any other embodiments even if not so illustrated.

FIG. 1 illustrates a radiation treatment system 10 for deliveringradiation in accordance with a treatment plan that is determined usingtechniques described herein. The system 10 includes a gantry 12 (in theform of an arm), a patient support 14 for supporting a patient, and acontrol system 18 for controlling an operation of the gantry 12. Thesystem 10 also includes a radiation source 20 that projects a beam 26 ofradiation towards a patient 28 while the patient 28 is supported onsupport 14, and a collimator system 22 for controlling a delivery of theradiation beam 26. The radiation source 20 can be configured to generatea cone beam, a fan beam, or other types of radiation beams in differentembodiments.

In the illustrated embodiments, the radiation source 20 is a treatmentradiation source for providing treatment energy. In other embodiments,in addition to being a treatment radiation source, the radiation source20 can also be a diagnostic radiation source for providing diagnosticenergy. In such cases, the system 10 will include an imager, such as theimager 100, located at an operative position relative to the source 20(e.g., under the support 14). In some embodiments, the treatment energyis generally those energies of 160 kilo-electron-volts (keV) or greater,and more typically 1 mega-electron-volts (MeV) or greater, anddiagnostic energy is generally those energies below the high energyrange, and more typically below 160 keV. In other embodiments, thetreatment energy and the diagnostic energy can have other energy levels,and refer to energies that are used for treatment and diagnosticpurposes, respectively. In some embodiments, the radiation source 20 isable to generate X-ray radiation at a plurality of photon energy levelswithin a range anywhere between approximately 10 keV and approximately20 MeV. Radiation sources capable of generating X-ray radiation atdifferent energy levels are described in U.S. patent application Ser.No. 10/033,327, entitled “RADIOTHERAPY APPARATUS EQUIPPED WITH ANARTICULABLE GANTRY FOR POSITIONING AN IMAGING UNIT,” filed on Nov. 2,2001, and U.S. patent application Ser. No. 10/687,573, entitled“MULTI-ENERGY X-RAY SOURCE,” filed on Oct. 15, 2003. In furtherembodiments, the radiation source 20 can be a diagnostic radiationsource. In the illustrated embodiments, the radiation source 20 iscoupled to the arm gantry 12. Alternatively, the radiation source 20 maybe located within a bore.

In the illustrated embodiments, the control system 18 includes aprocessor 54, such as a computer processor, coupled to a control 40. Thecontrol system 18 may also include a monitor 56 for displaying data andan input device 58, such as a keyboard or a mouse, for inputting data.In the illustrated embodiments, the gantry 12 is rotatable about thepatient 16, and during a treatment procedure, the gantry 12 rotatesabout the patient 16 (as in an arch-therapy). In other embodiments, thegantry 12 does not rote about the patient 16 during a treatmentprocedure. In such case, the gantry 12 may be fixed, and the patientsupport 14 is rotatable. The operation of the radiation source 20, thecollimator system 22, and the gantry 12 (if the gantry 12 is rotatable),are controlled by the control 40, which provides power and timingsignals to the radiation source 20 and the collimator system 22, andcontrols a rotational speed and position of the gantry 12, based onsignals received from the processor 54. Although the control 40 is shownas a separate component from the gantry 12 and the processor 54, inalternative embodiments, the control 40 can be a part of the gantry 12or the processor 54.

It should be noted that the system 10 is not limited to theconfiguration described above, and that the system 10 may have otherconfigurations in other embodiments. For example, in other embodiments,the system 10 may have a different shape. In other embodiments, theradiation source 20 of the system 10 may have different ranges ofmotions and/or degrees of freedom. For example, in other embodiments,the radiation source 20 may be rotatable about the patient 28 completelythrough a 360° range, or partially through a range that is less than360°. Also, in other embodiments, the radiation source 20 istranslatable relative to the patient 28. Further, the radiation source20 is not limited to delivering treatment energy in the form of x-ray,and may deliver other types of radiation energy. For example, in otherembodiments, the radiation source 20 may be a proton source fordelivering protons to treat patient, or other types of particle sourcefor delivering other types of particles for treating patient.

FIGS. 2 and 3 illustrate a method 200 of determining a radiationtreatment plan that may be used by the system 10 in accordance with someembodiments. The method 200 will be described with reference to treatinga target region TR using a radiation source 20 that rotates about thetarget region TR (e.g., 360° about the target region TR), as in an arctherapy (FIG. 4). However, it should be understood that the method 200is not limited to the example illustrated in FIG. 4, and that the method200 may be used to determine other treatment plans with a differentsetup. For example, in other embodiments, the method 200 may be used todetermine a treatment plan in which the radiation source 20 does notrotate completely about the TR, but only partially (e.g., less than 360°about the patient 28).

First, a number of dose calculation points are defined (step 202). Adose calculation point is used to represent a component that is a partof a divided treatment. In particular, the total dose of a treatment maybe divided into components. A broadly defined dose calculation pointcontains the dose delivered during some part of the treatment. The sumof doses from all dose calculation points is the total dose of thetreatment. The division of the treatment into components may be donewith respect to various parameters in different embodiments. In theillustrated example, the treatment is initially divided into threecomponents represented by dose calculation points DC1, DC2, DC3, whereinthe division is done with respect to the gantry angles such that DC1,DC2, DC3 represent respective 120° gantry ranges (FIG. 4). Division of atreatment based on gantry angles may be useful in determining treatmentplans for arc treatments. In other embodiments, the number of dosecalculation points may be different from three. For example a 360°treatment can be divided into 10° components, in which case, the numberof dose calculation points would be 36. Each component would cover thedose delivered in different 10° gantry angle intervals. In furtherembodiments, instead of having each dose calculation point representingan interval with a same range, the dose calculation points may representrespective intervals with different ranges (e.g., DC1 may representgantry angles from 0°-180°, DC2 may represent gantry angles from180°-300°, and DC3 may represent gantry angles from 300°-360°).

In the illustrated embodiments, for each of the dose calculation points,the radiation can be modeled by assuming radiation coming from one fixedgantry angle. For example, for the dose calculation point covering dosefrom 0° to 120°, the dose can be calculated by assuming that allradiation in this 0° to 120° interval is coming from 60° angle. It iseasier and faster to calculate the dose from a single fixed ganty anglethan from a curved path from 0° to 120°.

For each of the dose calculation points, the radiation that is desiredto be delivered is modeled by considering fluence. Fluence is the amountof radiation passing through a spatial region, and may be represented bya fluence map. A fluence map is a matrix that covers a spatial region(e.g., a plane). For each point in the plane, the fluence map definesthe amount of radiation passing through that element. FIG. 5 illustratesan example of a fluence map. In the example, the radiation source sendsradiation with strength 2. There is a block 502 (which may be, forexample, a leaf of a collimator) in the middle of radiation beamblocking half of the radiation passing through that block. For example,the 502 block may be extended half way to allow radiation to passthrough half of a prescribed region. Alternatively, the block 502 may beretracted to let radiation pass through the region half the time, andmay be dosed completely to prevent radiation from passing through theregion the other half the time. The fluence in the fluence plane is 0 inparts where the collimator leaves 504 block the radiation to prevent theradiation from passing through. The fluence is 2 where all the radiationfrom source reaches (and passes through) fluence plane. The fluence is 1where half of the radiation was blocked by the 502 block. The matrix offluence elements form a fluence map 00002120000.

In some cases, a computer user interface, such as a screen and an inputdevice, may be provided for allowing a user to input data for definingdose calculation points. For example, the screen may display one or moreinput fields for allowing the user to input the data, such as number ofdose calculation points, and treatment division parameters. The screenmay also display input fields for allowing user to input target regionsize, target region shape, maximum allowable dose, minimum requireddose, etc. The displaying of the input fields may be done in response toa processor (which may be the same processor 54, or a separateprocessor) and/or software executing a set of instruction. In suchcases, the processor and/or the software determines the dose calculationpoints by receiving input by the user.

Returning to FIG. 2, next, the processor and/or the software performsoptimization using the three defined dose calculation points DC1, DC2,DC3 (Step 204). As discussed, the regions represented by respective dosecalculation points DC1, DC2, DC3 are modeled with respective fluencemaps. In step 204, the processor and/or software runs the fluenceoptimization for some number of iterations (e.g., 100). The objective ofthe optimization is to get fluence maps that produce best dose inpatient 28 by optimizing the individual components in the fluence maps.In some cases, the optimization objective may be defined using DVH (dosevolume histogram) constraints in patient dose. Dose volume histogram isa graph (function) DVH(x) that tells which fraction of a defined volumereceives less than x dose, and DVH constraint is a constraint thatdescribes which shapes of DVH are preferred. For example, a user mayspecify (e.g., using a user interface) not to put more than 30 Gy doseto spine, but to keep the dose in target between 60 and 70 Gy. Theobjective is to find out the best fluence map configuration at thevarious dose points that will give the desired dose at the target, whileminimizing dose to healthy tissue outside the target DVH function andconstraints am well known in the art.

Next, the method moves to dose calculation point level 2, in which theinterval for each dose calculation point is halved such that thetreatment is modeled in six intervals (Step 206). The division can bedone by assuming that two adjacent dose calculation points at level 2have the same fluence as the parent fluence map at level 1. So the dosecalculation points DC1 and DC2 at level 2 would have a fluence map thatis equal to the fluence map of dose calculation point DC1 at level 1times 0.5. As a result of Step 206, six dose calculation points aremodeled with six fluence maps.

Next, the processor and/or the software runs a number (e.g., 100) ofiterations of fluence optimization again, this time using the dosecalculation points DC1-DC6 at level 2 (Step 208). The objective of theoptimization is to get fluence maps that produce best dose in patient 28by optimizing the individual components in the fluence maps for the sixdose calculation points DC1-DC6. The technique for performing theoptimization in step 208 may be the same as that described withreference to step 204.

The complexity of all fluences at level 2 is then evaluated (Step 210).Various techniques may be used to evaluate the complexity of a fluenceat any given level. In some embodiments, the complexity of a fluence isrepresented by the complexity of its corresponding fluence map. In suchcases, the complexity of the fluence map is calculated by converting thefluence map to machine parameters, and calculating the time required tomove the leaves based on the machine parameters. The more the time thatis required to move the leaves to achieve a fluence profile, the morecomplex is the fluence. In other embodiments, instead of, or in additionto, using the time required to move the leaves to determine a complexityof a fluence, other parameters may also be used. For example, in otherembodiments, the number of leaves that need to be moved in order toachieve a fluence may also be used to determine the complexity of thefluence. In such cases, the more the number of leaves that need to bemoved, the more the complex the fluence. In further embodiments, thedistance that the leaf(s) need to travel may also be used to determinethe complexity of the fluence. In such cases, the more the distance, themore the complex the fluence. In other embodiments, any combination ofthe above parameters and/or other parameters not described herein may beused to determine a complexity of a fluence.

Next, the processor and/or the software converts all but the mostcomplex fluence to machine parameters by using a leaf sequencingalgorithm (Step 212). FIG. 6 illustrates an example of converting afluence map 600 to machine parameters using a leaf sequencing technique.As shown in the figure, the fluence represented by the fluence map 600can be converted to leaf sequence (an example of machine parameter),which in the example, has four leaf positions 602 a-402 d at respectivefour time points t=1, 2, 3, 4. In particular, the leaves would first bedosed 602 a at time step 1. Then the leaves would be open in the regionsshown in the leaf configuration 602 b at time step 2. Then the leaveswould be open in the regions shown in the leaf configuration 602 c attime step 3. Then the leaves would be closed again 602 d (time step 6).The fluence components 604 a-604 d for the respective leaf positions 602a-602 d are also shown. As shown in the figure, the sum of the fluencecomponents 604 a-604 d equals the fluence map 600. In the illustratedexample, the most complex region is in the dose calculation point 5 atlevel 2 (FIG. 3). Thus, the processor and/or software converts all ofthe fluence to machine parameters, except that for dose calculationpoint 5. In some cases, the processor and/or software determines whethera level of complexity of a fluence is below a prescribed threshold, andconverts the corresponding fluence map to one or more machine parametersfor the dose calculation point when it determines that the level ofcomplexity is below the prescribed threshold. In other embodiments, theprocessor and/or software determines whether a level of complexity of afluence is above a prescribed threshold, and converts the correspondingfluence map to one or more machine parameters for the dose calculationpoint when it determines that the level of complexity is above theprescribed threshold.

In the above example, each of the leaf positions 602 a-602 d is amachine parameter that corresponds with a machine control point. As usedin this application, the term “machine control point” or “control point”refers to a component of a treatment plan that includes one or moremachine parameters for prescribing a part of the treatment plan. Forexample, a treatment plan may be prescribed using N number of machinecontrol points, each of which contains machine parameter(s) (such as anyor a combination of: gantry speed, gantry angle, beam-on/activationsignal, beam-off/deactivation signal, collimator position, leaves'positions, couch position, beam energy, beam type, dose (or monitorunits), and dose rate (or beam intensity)) for defining a part of thetreatment plan. The number of machine control points that correspondwith a fluence map may vary. For example, a complex fluence map may beconverted into a higher number of leaves' positions (machine controlpoints), while a simpler fluence map may only require fewer machinecontrol points to achieve the desired fluence. In some cases, the totalnumber of machine control points in a complete treatment plan may be inthe range of hundreds or even thousands. In the illustrated embodiments,the number of machine control points are higher than the number of dosecalculation points. However, the dose at the dose calculation point isused to evaluate the machine parameters, thereby obviating the need tocalculate dose for each of the machine control points, which in somecases, may take up a significant amount of computation time andresources. It has been discovered that determining dose at dosecalculation points without doing the same at all of the machine controlpoints can achieve a treatment plan that is sufficiently accurate.

It should be noted that a machine control point may be modeled withother parameters instead of, or in addition to, leaf sequencing. FIG. 7illustrates an example of converting a fluence map 700 to machineparameters using a leaf sequencing technique. As shown in the figure,the fluence represented by the fluence map 700 can be converted toradiation source positions (another example of machine parameters),which in the example, has four radiation source positions 702 a-702 d atrespective four time points. In particular, the radiation source wouldfirst be placed at positions 702 a-702 b at respective time steps 1-4.The fluence components 704 a-704 d for the respective radiation sourcepositions 702 a-702 d are also shown. As shown in the figure, the sum ofthe fluence components 704 a-704 d equals the fluence map 700. In theillustrated example, each of the radiation source positions 702 a-702 dcorresponds with a machine control point. Thus, in the example, thereare four machine control points that correspond with the fluence map atthe corresponding dose calculation point. The number of machine controlpoints that correspond with a fluence map may vary. For example, acomplex fluence map may be converted into a higher number of radiationsource positions (machine control points), while a simpler fluence mapmay only require fewer machine control points to achieve the desiredfluence. In the above example, the radiation source is illustrated astranslating. However, the same principle can be used with a radiationsource 20 that rotates, with each time step corresponding to one machinecontrol point.

In the above embodiments, the number of machine control points for eachdose calculation point is constant. In other embodiment, the number ofmachine control points may be different for different dose calculationpoints, depending on the complexity of the fluence for the particulardose calculation point. Regardless of the number of machine controlpoints, the dose calculation is always performed at the dose calculationpoints. There will be some error because the angle changes duringrotation, but the error could be acceptable if the separation of finaldose calculation points is small enough. For example there could be onedose calculation points every 1 or 2 degrees, but within that 1 or 2degree range, there could be 1, 2, 3, 10, or 100 machine control points.It would be a waste of computation time to calculate the dose with 1/100degree interval, because that level of accuracy is not required. Thechange in fluence may be significant due to leaf movement, but thechange due to angular rotation may be too small to justify calculatingdose at every machine control point.

Returning to FIG. 2, the optimization is continued (Step 214). Inparticular, gradient back projection technique is used in theoptimization for fluence maps, and direct aperture method is used in theoptimization for regions modeled with machine control points. Ingradient back projection method, the derivatives of the objectivefunction with respect to change in fluence are calculated in gradientmap. It is called gradient back projection because the gradients arecalculated in some volume elements, and the derivatives of the objectivefunction at those volume elements are projected back and summed tofluence plane to form a gradient plane. Then the fluence is modified byadding the gradient plane to fluence plane (first the gradient planevalues are multiplied by some scalar, because the scale is different).Direct aperture methods refer to directly modeling the treatment inmachine parameters, wherein the gradient of objective function iscalculated with respect to machine parameters and the machine parametersare changed according to the gradients. Thus, in gradient backprojection technique, the objective function gradient is calculated withrespect to the fluence sum elements, and in direct aperture technique,the objective function gradient is calculated with respect to leafpositions (FIG. 6). In the illustrated embodiments, the dose is stillcalculated at dose calculation points. The average fluence from machinecontrol points is accumulated at dose calculation point, and the dose isassumed to come from the dose calculation point. The optimizationobjective of the optimization in step 214 is the same as that describedpreviously. In particular, the machine control points are modified sothat they produce a desired fluence in the corresponding dosecalculation point (which may represents a range of gantry angles forpositions of the radiation source). The goal is to produce an optimalradiation fluence.

In some embodiments, the optimization in step 214 utilizes an iterativetechnique in which more and more dose calculation points areprogressively converted into machine parameters as the number ofiterations increases. Alternatively, the process 200 may repeat the stepof converting fluence to machine parameters (Step 212) and the step ofoptimization (Step 214) until all of the dose calculation points (exceptthe ones with the most complex fluence) modeled with fluence maps areconverted to machine parameters at machine control points. Thedetermined machine parameters are based on the complexity of fluencefrom other directions. Therefore the more demanding leaf movements havebeen considered, except for the range 240-300 corresponding with dosecalculation point 5 at level 2 (FIG. 3). For this range, because thereis limited time to move leaves to achieve a complex fluence, theresulting fluence may only be partially accomplished. In order toaddress this, for this range which has been determined to have the mostcomplex fluence, the processor and/or software uses a slower gantryrotation to determine the portion of the treatment that corresponds withthis gantry range. With slower gantry rotation, there is more time tomove the leaves and the more complex fluence can be converted to machineparameters more accurately (Step 216). In other embodiments, in additionto prescribing a slower gantry speed, the processor and/or software canalso use more control points (e.g., more machine control points and/ormore dose calculation points) for the complex region(s). Such techniquewill also allow the more complex fluence to be accomplished moreaccurately. Also, in other embodiments, different maximum speeds ofgantry rotation may be prescribed for different gantry ranges/intervals.In such cases, the machine parameters are determined for thecorresponding control points based on the prescribed maximum speed forthe corresponding gantry range/interval.

After all of the fluence has been converted to machine parameters atmachine control points, the processor and/or software performsoptimization again using the machine parameters for all of the dosecalculation points (Step 218). The objective of this optimization is tofine tune the previously determined machine parameters such that theyproduce the desired fluence at the various dose calculation points. Theresulting machine parameters for the machine control points are thenstored as a treatment plan in a medium for later use (Step 220).

In some embodiments, the method 200 may go one level further, e.g., tolevel 3, where dose calculation points are increased such that the dosecalculation points and machine control points could coincide, but thisis not always necessary. This is because the treatment is modeled usingfinal accuracy of machine control points inside the dose calculationpoint and keeping the machine control points valid (so that the machinewould be able to deliver the treatment as presented in machine controlpoints). However, the dose is not calculated from the direction of allmachine control points. The total radiation fluence from all of themachine control points belonging to one dose calculation points is firstcalculated (this is a fast step). Then the dose in patient is calculatedfrom the fluence map in control point. Therefore the part of thetreatment modeled as machine control points is a valid treatment. Thedivision to even more dose calculation points is done to decreaseanother source of error in dose calculation. Large angular separationbetween dose calculation points may also produce error in dosecalculation. Thus, it is desirable that there be enough dose calculationpoints at final level to have good enough angular dose calculationaccuracy, but that number can be smaller that the required number ofmachine control points. In other embodiments, it could also be same.

So even when the treatment in dose calculation point is modeled asmachine parameters, the fluence of a treatment resulting from thosemachine control points is first calculated and the dose in patient iscalculated from that fluence. Maintaining the delivery information inmachine control points accounts for machine limitation, such as leafspeed and geometry. On the other hand, when the delivery in dosecalculation point is modeled as a fluence only, it ignores most of themachine limitations. The unconstrainted optimization is faster and lesssensitive to local minima.

In the above embodiments, the processor and/or software evaluates thecomplexity of fluence in order to determine which control points tochange in an iteration, and the conversion starts from most simpleinterval. Such technique allows the simpler parts of the treatment planto be determined early on. In other embodiments, the conversion may bebased on a different technique. For example, in other embodiments, theconversion may start from most complex interval. Such technique wouldallow the optimizer to determine the most difficult conversion problemsearly on in the optimization process. In other embodiments, instead ofdetermining control points to convert based on complexity, all of thecontrol points may be converted regardless of the fluence complexity. Infurther embodiments, the processor and/or software may use spatialorder. For example, control points in first range of angles 0°-10° maybe converted, then control points for angles 10°-20° are converted, andthen the control points for angles 20°-30° are converted. This techniqueremoves the connectivity problem of machine parameters.

In the above embodiments, the initial number of dose calculation pointsis small, and is then increased progressively (e.g., from dosecalculation level 1 to dose calculation level 2) as the treatment planis refined. There are two benefits in having small number of dosecalculation points initially. First, the optimization may beaccomplished faster because the total dose can be evaluated more quicklyusing fewer number of dose calculation points. Second, the leafsequencing may be accomplished easier because there is more time (thetreatment time modeled in a dose calculation interval is longer) for theleaves to move to produce the desired fluence. As illustrated above, atsome point during the treatment planning phase, the fluence maps aredesired to be converted to machine parameters. The conversion is notperfect—i.e., because of machine limitation, some parts of the resultingfluence may be different from that calculated at the dose calculationpoints. This means that the resulting dose may be different from theoptimized one. After the conversion has been done, the optimization canbe continued in that interval using direct machine parameteroptimization methods. This way the treatment planning can first benefitfrom quick convergence to a good solution (with less consideration ofmachine limits), and then can decrease the err resulting from theconversion of fluence maps to machine parameters using direct machineparameter optimization (applying machine limits). As illustrated above,the process could first model all intervals of the treatment usingfluence maps. Then one or more of the fluence maps are converted tomachine parameters. Optimization is continued, in which fluenceoptimization is used for intervals modeled by fluence maps, and directmachine parameter optimization is used for intervals that are modeled bymachine parameters. The errors resulting from the conversion aredecreased very efficiently by other intervals modeled by fluence maps.In such technique, more and more intervals are converted to machineparameters as the optimization progresses. Finally the treatment ismodeled by machine parameters.

In some cases, practical solution would be to start with only a few dosecalculation points, all modeled by unconstrained fluences. Just beforethe number of dose calculation points is increased, the fluences areconverted to machine control points. Because of the small number of dosecalculation points, the time they model is longer and the leafsequencing is easier. Then, to decrease the dose calculation errorproduced by angular separation, the number of dose calculation points isincreased. However, it may be desirable to perform the transition fromunconstrained fluences to machine control points in early phase due toeasier leaf sequencing.

In other embodiments, instead of having two dose calculation pointlevels before step 212, the method 200 may include additional dosecalculation point level(s). Also, in other embodiments, the dosecalculation points may increase at any part of the method 200. Forexample, the method 200 can repeat steps 206, 208 to increase dosecalculation points and perform optimization at any time during themethod 200 (See arrows 230, 240, 250 in FIG. 2). In further embodiments,the method 200 may include only one dose calculation point level. Insuch cases, steps 206, 208 may be omitted. Also, in other embodiments,instead of increasing dose calculation points by subdividing theintervals for all of the dose calculation points, only the intervals fora subset of all the dose calculation points are subdivided to increasethe number of dose calculation points. In any of the embodimentsdescribed herein, the optimization used by the method 200 is aniterative technique, in which cases, the number of dose calculationpoints may be increased at any one of the iterations.

In the above embodiments, the process 200 initially models parts of atreatment (e.g., an arc treatment) in 120° intervals of gantry angleswith fluence maps. In other embodiments, the treatment may be modeled inother intervals (e.g., 1°, 5°, 10°, etc.) of gantry angles. Also, inother embodiments, the treatment may be modeled initially using fluencemaps for some intervals, and machine parameters (e.g., leaf positions)for other intervals. For example, in other embodiments, the treatmentmay be divided into components, for example in 10 degree intervals ingantry angle, in which the first three intervals may be modeled byfluence maps and the rest of 33 intervals with direct machineparameters. Both modeling techniques to present part(s) of treatmenthave their advantages. A fluence map can very efficiently representradiation from some direction and there are very efficient optimizationmethods to find good fluence maps. However, in some cases, it may bedifficult to model machine limitations with fluence map optimization. Onthe other hand, if a part of the treatment in an interval is modeledusing machine parameters, it is easier to apply machine limitations inoptimization. However, these optimization methods may be slower, moreconstrained, and may be more easily trapping into a local minima.

In the above embodiments, the division of the treatment into componentsis done with respect to the gantry angles. In other embodiments, thedivision of the treatment into components may be done with respect toother parameters. For example, in other embodiments, the dosecalculation points may be defined so that they correspond withrespective time. For example a 60 second treatment can be divided into 6dose calculation points. First dose calculation point would cover thedose delivered from 0 second to 10 second, second dose calculation pointfrom 10 second to 20 second, and so on.

In other embodiments, the dose calculation points may be defined so thatthey correspond with monitor units. Monitor units is the amount ofradiation units produced by the machine 10. For example a 600 MUtreatment may be divided into 3 dose calculation points. First dosecalculation point would cover the dose delivered from 0 to 200 MU,second dose calculation point would cover the dose delivered from 200 to400 MU, and third dose calculation point would cover the dose deliveredfrom 400 to 600 MU.

In other embodiments, the dose calculation points may be defined so thatthey correspond with respective regions of the patient 28 (e.g.,different parts of a target region).

In other embodiments, the dose calculation points may be defined suchthat they correspond to some other geometric parameters. For example,the dose calculation points may be defined such that they correspondwith respective positions of the support 14 (e.g., couch) along itslongitudinal axis, with respective angles of the support 14, orrespective collimator angles.

In the above embodiments, the treatment is described as involvingrotating the radiation source 20 at least partially around the patient28. However, in other embodiments, the treatment may also involvetranslating the patient 28 relative to the radiation source 20. FIG. 8illustrates another embodiment of a radiation system 10 in which thepatient support 14 is translatable. The system 10 includes a gantry 12having an arm 800, a support structure 802 to which the gantry isrotatably coupled, and a radiation source 20. In the illustratedembodiments, the patient support 14 is coupled to a positioner 804,which is for translating the patient support 14 in a back and forthmanner. During use, the radiation source 20 rotates at least partiallyaround the patient 28 so that radiation can be delivered to targetregion from a plurality of gantry angles. Also, during use, thepositioner 804 moves the patient support 14 along the longitudinal axis806 (the Z-axis) forward 808 and backward 810, so that different partsof the target region along the axis 806 may receive radiation from aplurality of gantry angles. Thus, by coupling the rotation of theradiation source 20 with the translation of the patient support 14, anypart of the target region along the axis 806 may be treated by radiationdelivered from a plurality of gantry angles. The system 10 of FIG. 8 isadvantageous for treating target that cannot be irradiated with onegantry rotation using existing systems. For example, the system 10 maybe used to perform whole body irradiation or irradiation of long tumornear spine with one continuous radiation trajectory. Also, providingback and forth trajectories is desirable in that it results in controlpoints that represent independent degrees of freedom in the optimizationthat have independent constraints. In addition, translating the patientsupport 14 in a back and forth manner during a treatment saves time. Thetrajectory is simple and easy to understand spatially, and savestreatment planning time. This allows the trajectory to be evaluatedeasily, and used for many purposes. In some cases, the radiation source20 may be stationary while the patient support 14 is translated back andforth. This allows radiation to be modulated along the axis 806 suchthat different parts of the target region along the axis 808 receivesdifferent amount of radiation (i.e., for a given gantry angle).

The above described trajectory also allows collision between radiationdevice and patient 28/support 14 to prevented more easily. This isbecause in the above described trajectory, the radiation source movesrelative to the patient 28 and support 14 in paths that form a cylinder.Cylinder is relatively easy to understand spatially, and therefore, auser may more easily evaluate a risk of collision for such trajectorythan for a more complex trajectory. In some embodiments, the system 10uses a collision prevention mechanism that involves comparing an imageof the patient 28 and the support 14 with a cylinder/ring with aspecific radius, and checking to see if the cylinder/ring collides withthe patient 28 or support 14. Because the support 14 moves back andforth along the same route, the collision detection cylinder will be thesame for all passes. This simplifies the collision detection.

In other embodiments, instead of moving the patient support 14, theradiation source 20 may be translatable in the Z-axis direction. Ineither case, the patient support 14 and the radiation source 20 may beconsidered as moveable or translatable relative to each other. Infurther embodiments, the radiation source 20 may be configured to tiltabout an axis (e.g., axis 812) that forms an angle (e.g., 90°) relativeto the longitudinal axis 806. During use, the radiation source 20 tiltsabout the axis 812 so that radiation may be delivered to different partsof the target region along the axis 806. The radiation source 20 alsorotates at least partially around the patient 28 so that it can deliverradiation to the target region from a plurality of gantry angles.

In other embodiments, the patient support 14 may be configured to rotateduring the treatment. FIG. 9 illustrates another embodiment of aradiation system 10 in which the patient support 14 is configured torotate in correspondence with the rotation of the radiation source 20.In the illustrated embodiments, the patient 28 with the support 14 isshifted away from the isocenter 900. During use, the radiation source 20rotates at least partially along path 902 to deliver radiation to thepatient 28 from a plurality of gantry angles. In correspondence with theposition of the radiation source 20, the patient support 14 isconfigured (e.g., using a positioner) to rotate at least partially alongpath 904. As shown in the figure, at another point in time during atreatment procedure, the radiation source is moved to another gantryposition (represented by reference numeral 20′), and accordingly, thesupport and the patient are moved dynamically around spatial region 908such that the support and the patient is at operative positions(represented by reference numerals 14′, 28′) opposite from the radiationsource. Such configuration is beneficial in that it provides relativelymore room between the patient 28 and the radiation source 20, therebyallowing bigger and heavier patient (which may otherwise be impossibleif the support 14 is closer to the isocenter) to be treated. Suchfeature is also advantageous in that it allows the patient 28 who isbeing treated to feel more comfortable (especially if the patient 28 isclaustrophobic), and reduces the risk of having the patient 28/support14 collide with the radiation source 20. Such feature is alsoadvantageous in that it provides more room between the patient and theradiation source 20 without changing a size of a bore (or aconfiguration of an arm if an arm is used instead of a bore) of anexisting machine. Another advantage of such feature is that it allows awider target area to be treated. This is because as the distance betweenthe patient and the radiation source is increased, the fan shape of theradiation beam will “fan-out” or diverge more before it reaches thepatient. In the illustrated embodiments, the radiation source 20 and thepatient support 14 (with the patient 28) both rotate at least partiallyaround a spatial region 908, and about an axis (which may coincide with,or locate next to, isocenter 900). It should be noted that the term“around” (e.g., as in “around a spatial region”) is not limited tomovement by the support 14 or source 20 that is in an arc or circularpath, and that the term “around” may refer to movement by the support 14or source 20 that is in other path shapes in different embodiments, aslong as the trajectory of the support 14 or source 20 forms a loop thatsurrounds the spatial region, or a partial loop (e.g., an arc that isless than 360°) that partially surrounds a part of the spatial region.In other embodiments, the radiation source 20 and the patient support 14(with the patient 28) may rotate about different respective axes thatare parallel to, and spaced apart from, each other.

FIG. 10A illustrates a patient support system 1000 that may be used tomove the patient support 14 in the manner described in the embodiment ofFIG. 9. The patient support system 1000 includes a base 1002, an arm1004, and the patient support 14. The arm 1004 has a first end 1006 thatis rotatably coupled to the base 1002, and a second end 1008 that isrotatably coupled to the support 14. In particular, the arm 1004 isrotatable about an axis 1010 relative to the base 1002, and is alsorotatable about another axis 1012 relative to the support 14. Duringuse, a positioning device (e.g., a motor) in the base 1002 rotates thearm 1004. As the arm 1004 rotates about the axis 1010, the support 14 isrotated relative to the arm 1004 about the axis 1012 such that thesupport surface of the support 14 always faces upward while the support14 is rotated about the axis 1010. In other embodiments, the patientsupport system 1000 may further include a positioning device coupledbetween the support 14 and the arm 1004 for translating the support 14back and forth along axis 1014. This allows the patient support system1000 to be used in a similar manner as that described with reference toFIG. 8. It should be noted that the patient support system 1000 is notlimited to the configuration described previously, and that the patientsupport system 1000 may have other configurations (e.g., may havedifferent degrees of freedom) in other embodiments, as long as thepatient support 14 can move at least partially around the patient 16.

FIG. 10B illustrates another patient support system 1040 that may beused to move the patient support 14 in the manner described in theembodiment of FIG. 9. The patient support system 1040 includes a base1002, a first positioner 1050, a second positioner 1052, and the patientsupport 14. The first positioner 1050 is configured to move the patientsupport 14 vertically, e.g., in an upward or downward direction along avertical axis, as illustrated by the arrow 1054. The second positioner1052 is configured to move the patient support 14 in a lateraldirection, e.g., in a left or right direction along a horizontal axis,as illustrated by the arrow 1056. The patient support 14 is translatablerelative to the second positioner 1052 along its longitudinal axis, asillustrated by the arrow 1058. In other embodiments, the patient support14 may be fixedly secured to the second positioner 1052. In such cases,the second positioner 1052 may be configured to translate relative tothe first positioner 1050 in both the lateral direction 1056 and thelongitudinal direction 1058. Also, in further embodiments, the first andsecond positioners 1050, 1052 may be parts of a positioner system. Itshould be noted that the patient support system 1040 is not limited tothe examples described, and that the patient support system 1040 mayhave other configurations. For example, in other embodiments, thepatient support system 1040 may have additional degree(s) of freedom inthe positioning of the patient support 14. Also, in other embodiments,instead of having two positioners 1050, 1052 that translate in differentrespective directions, the patient support system 1040 may have onepositioner for moving the patient support 14 in both the verticaldirection 1054, and the lateral direction 1056. In such cases, thepositioner may include a first component for translating the patientsupport 14 along a first axis (e.g., a vertical axis), and a secondcomponent for translating the patient support 14 along a second axis(e.g., a horizontal axis).

During use of the patient support system 1040, the patient supportsystem 1040 is aligned with the radiation source 12, like that shown inFIG. 9. The positioners 1050, 1052 are then operated to move the patientsupport 14 along path 904 in one direction, while the radiation source12 is moved along path 902 in the same direction but on the oppositeside of the spatial region 908 facing towards the patient support 14. Inthe illustrated embodiments, the movement of the patient support 14along the path 904 may be accomplished by simultaneously translating thepatient support 14 in both the vertical direction 1054 and the lateraldirection 1056, and synchronizing the sliding motions in these twodirections in the manner shown in graph 1060. In the graph 1060, thex-axis represents time, and the y-axis represents the position for eachof the vertical and lateral movements. As shown in the graph 1060, thesliding of the patient support 14 in the lateral direction 1056(represented by the solid line) is performed in a sinusoidal manner, andthe sliding of the patient support 14 in the vertical direction 1054(represented by the dashed line) is also performed in a sinusoidalmanner. Synchronizing the sliding motions in the lateral and verticaldirections 1056, 1054 (along the horizontal and vertical axes,respectively) to a common time base like that shown in graph 1060 willcause rotation of the patient support 14 in trajectory 904. In someembodiments, the motions in the lateral and vertical directions occursimultaneously so that the resulting path has an arc or circular shape.In other embodiments, the motions in the lateral and vertical directionsmay occur in an alternating manner such that the resulting path has azig-zag configuration. Also, in further embodiments, the zig-zag motionmay be implemented using translation along other axes (e.g., translationalong direction 1054 and along the longitudinal direction 1058, ortranslation along direction 1056 and along the longitudinal direction1058). In any of the embodiments described herein, the movement of thepatient support 14 may involve accelerating and/or decelerating thepatient support 14 smoothly to avoid moving the patient in an abruptmanner.

It should be noted that the trajectory technique described withreference to FIGS. 9-10 may be implemented for a treatment system (e.g.,a radiation treatment system configured to deliver treatment radiationbeam), or a diagnostic system (e.g., a radiation diagnostic system fordelivering radiation beam for imaging purpose). Also, in any of theembodiments described herein, the patient support 14 may be configuredto tilt about one or more axes. In such cases, the patient support 14may further include a device (e.g., a belt, a harness, etc.) forsecuring the patient relative to the patient support 14.

It should be noted that any of the trajectories described herein(including the trajectory described with reference to FIGS. 8 and 9) maybe used in the treatment planning method 200 described with reference toFIG. 2. For example, with respect to the embodiments of FIG. 9, themethod 200 may involve defining a parameter that corresponds withrotation of the patient support 14. In such cases, the rotationparameter may be optimized during the method 200 (e.g., in step 204,208, 214, and/or 218). Similarly, with respect to the embodiment of FIG.8, the method 200 may involve defining a parameter that corresponds witha translation of the patient support 14. In such cases, the translationparameter may be optimized during the method 200 (e.g., in step 204,208, 214, and/or 218). As discussed, providing back and forthtrajectories is desirable in that it results in control points thatrepresent independent degrees of freedom in the optimization that haveindependent constraints. As used in this specification, the term“optimization” (or variation thereof—e.g., optimizes, optimizing, etc.)refers to the act of making something better, which may involve changinga value of a parameter, wherein the changing of the value may beperformed manually by a user, or automatically using an optimizationsoftware.

FIG. 11A illustrates an example of a user interface 1100 that may allowa user to determine a treatment plan in accordance with someembodiments. As used in this specification, the term “user” may refer toa single person, or a plurality of persons. In some cases, the userinterface 1100 may be used in the method 200 to determine a treatmentplan. The user interface 1100 includes a screen 1102 displaying an inputinterface 1104. The input interface 1104 may be generated by a processorthat executes a set of instruction programmed to provide the image ofthe input interface 1104. In the illustrated embodiments, the inputinterface 1104 includes a table 1106 having fields that allow the userto input parameters and/or values. In the illustrated example, the userhas defined in table 1106 control points 1108, parameter 1110 for theallowable starting point of support 14, parameter 1112 for allowableending point of support 14, parameter 1114 for allowable gantry startingangle, and parameter 1116 for allowable gantry ending angle. As shown inthe example, a control point may represent a single point (e.g., “0,”“1,” “2”), or an interval between two points (e.g., “0-1 interval,” “1-2interval”). The table 1106 includes various input fields for allowingthe user to input values for the parameters at different control points.As shown in the example, a value may be a numerical value, or aninstruction (e.g., “interpolate”—which specifies that values for thecorresponding control point are to be calculated in accordance with aprescribed scheme). In some embodiments, the user needs not enter all orany value for the input fields. In such cases, the processor/softwarefor determining the treatment plan is configured to determine the valuesfor the various fields in the table 1106.

In the illustrated example, the trajectory is defined by the controlpoints 1108, wherein each control point 108 defines a region inparameter space. The optimized trajectory has to pass through thedefined region before proceeding to the next control point 108. Theallowed region (range of parameters) between the control points is alsodefined. Thus, the control points define the region where the machinecontrol points must be placed. In some cases, the processor/software fordetermining the treatment plan is configured to generate machine controlpoints based on these rules and the defined parameters. For example, assimilarly discussed with reference to FIG. 2, the processor/software mayperform optimization based on geometric properties of target region(s)and healthy region(s). The processor/software may then continue with theoptimization using dose based method(s), e.g., direct aperture method,or fluence based method. In some embodiments, the user interface 1100allows the user to input initial values for some or all of theparameters. During the optimization process, the processor/softwareoptimizes the values based on certain user-defined constraints (e.g.,size, shape, and location of target, path of source, etc.). In otherembodiments, the processor/software may be configured to determine thevalues for the parameters without any initial input values from theuser.

In the illustrated example of FIG. 11A, the trajectory would move thesupport 14 from 0 cm to 40 cm in the Z direction (from control point 0to control point 1), and back to 0 cm (from control point 1 to controlpoint 2). The gantry 12 would rotate from somewhere between 0° and 45°to between 315° and 360°, and back to between 0° and 45°. TheZ-positions of the support 14 would be interpolated (e.g., linearly, orusing some other interpolation scheme) between the control points. Insome embodiments, the optimizer of the processor/software that is usedto perform method 200 is configured to determine the route between thecontrol points for gantry angles in the 0° to 360° interval.

In some cases, the user interface 1100 also allows the user to performsimple operations on defined trajectory. For example, in someembodiments, the trajectory of FIG. 11A may be stretched in theZ-direction by applying a multiplication of 2 in the Z-direction of thesupport 14. After the multiplication operation, the trajectory would bethat shown in FIG. 11B. In other embodiments, at least part of thetrajectory may be shifted. For example, the support 14 may be translatedin the Z-direction by −20 can from the trajectory of FIG. 11B, whichwill result in the trajectory of FIG. 11C.

In any of the embodiments described herein, the range of relative motionbetween the support 14 and the radiation source (or a referencelocation) can be a value that is between 5 cm and 50 cm. This range isadequate if the target is one connected region. In other embodiments, ifthe target includes multiple regions (e.g., which may be separated fromeach other) desired to be treated, then the range of relative motionbetween the patient support 14 and the radiation source could beanywhere between 5 cm and 2 m.

In some embodiments, the user interface 1100 allows the user to save thedesigned trajectory in a medium. The trajectory may be saved as a partof a treatment plan, which will be used later in a treatment procedure.Alternatively, or additionally, the trajectory may be saved as atrajectory class. In some cases, the trajectory classes may be organizedbased on specific machines (e.g., different machines may have differentclasses of trajectories), patient anatomy, location of target regions,sizes of target regions, shapes of target regions, and/or other diseasespecific factors. In such cases, a user may retrieve a trajectory fromone of the available trajectory classes, based on the specific machine,target region's shape, size, and location, and type of disease. The usermay then revise the retrieved trajectory to fine-tune it so that is canbe better used for a specific treatment for a specific patient. Forexample, the user may perform a multiplication and/or an addingprocedure for any part (e.g., a parameter type) of the trajectory, suchas those discussed with reference to FIGS. 11B and 11C, to thereby fitthe dimensions and/or positions of a target in a specific patient.

It should be noted that the type of parameters that may be defined usingthe user interface 1100 is not limited to the example discussed, andthat the user interface 1100 may allow the user to define otherparameters, such as gantry angle, positions (e.g., x, y, z) of support14, orientations (O_(x), O_(y), O_(z)) of support 14, dose (e.g., usermay specify whether dose is to be delivered for a control point), doserate, leaves' positions, and speed limits (e.g., of gantry rotation,leaves movements, support 14 movements, etc.).

As illustrated in the above embodiments, the user interface 1100provides a flexible method for a planner to communicate to the optimizerwhich class of trajectories is considered for a specific case. Thetrajectory is defined as a set of control points, in which someparameters are to be optimized, and other parameters are to beinterpolated. In some embodiments, parameters that are not optimized areinterpolated using an interpolation scheme. The user interface 1100 alsoallows ranges to be defined, and provides tools for a user to manipulatethe trajectory class. In some cases, the parameters to be optimized maybe different for different intervals of the treatment. Thus, the userinterface 1100 provides a tool for allowing a user to define atrajectory that is flexible enough for different applications, and iseasy to converge to a good solution (because not all of the parametersneed to be optimized—some of the parameters may be interpolated).

Although the above embodiments have been described with reference todelivering treatment radiation that is in the form of x-rays, in otherembodiments, the system and technique described herein may be used forother types of treatment energy. For examples, in other embodiments, inother embodiments, the radiation source 20 may be a proton source fordelivering protons to treat a patient, or an electron source fordelivering electrons. Accordingly, embodiments of the treatment planningtechnique described herein may be used to determine treatment plan forother types of treatment, such as proton treatment. Also, it should benoted that the term “collimator” is not limited to a device havingleaves for blocking radiation, and may refer to a device having one ormore jaws or jaw blocks. Thus, a position of a collimator may refer toposition of leaves of a collimator, position of collimator jaws, or aglobal position of the collimator itself relative to some coordinatesystem (e.g., a position of the collimator relative to a gantry orrelative to a radiation machine, etc.).

Computer System Architecture

FIG. 12 is a block diagram that illustrates an embodiment of a computersystem 1200 upon which an embodiment of the invention may beimplemented. Computer system 1200 includes a bus 1202 or othercommunication mechanism for communicating information, and a processor1204 coupled with the bus 1202 for processing information. The processor1204 may be an example of the processor 54 of FIG. 1, or anotherprocessor that is used to perform various functions described herein. Insome cases, the computer system 1200 may be used to implement theprocessor 54. The computer system 1200 also includes a main memory 1206,such as a random access memory (RAM) or other dynamic storage device,coupled to the bus 1202 for storing information and instructions to beexecuted by the processor 1204. The main memory 1206 also may be usedfor storing temporary variables or other intermediate information duringexecution of instructions to be executed by the processor 1204. Thecomputer system 1200 further includes a read only memory (ROM) 1208 orother static storage device coupled to the bus 1202 for storing staticinformation and instructions for the processor 1204. A data storagedevice 1210, such as a magnetic disk or optical disk, is provided andcoupled to the bus 1202 for storing information and instructions.

The computer system 1200 may be coupled via the bus 1202 to a display1212, such as a cathode ray tube (CRT), for displaying information to auser. An input device 1214, including alphanumeric and other keys, iscoupled to the bus 1202 for communicating information and commandselections to processor 1204. Another type of user input device iscursor control 1216, such as a mouse, a trackball, or cursor directionkeys for communicating direction information and command selections toprocessor 1204 and for controlling cursor movement on display 1212. Thisinput device typically has two degrees of freedom in two axes, a firstaxis (e.g., x) and a second axis (e.g., y), that allows the device tospecify positions in a plane.

The computer system 1200 may be used for performing various functions(e.g., calculation) in accordance with the embodiments described herein.According to one embodiment, such use is provided by computer system1200 in response to processor 1204 executing one or more sequences ofone or more instructions contained in the main memory 1206. Suchinstructions may be read into the main memory 1206 from anothercomputer-readable medium, such as storage device 1210. Execution of thesequences of instructions contained in the main memory 1206 causes theprocessor 1204 to perform the process steps described herein. One ormore processors in a multi-processing arrangement may also be employedto execute the sequences of instructions contained in the main memory1206. In alternative embodiments, hard-wired circuitry may be used inplace of or in combination with software instructions to implement theinvention. Thus, embodiments of the invention are not limited to anyspecific combination of hardware circuitry and software.

The term “computer-readable medium” as used herein refers to any mediumthat participates in providing instructions to the processor 1204 forexecution. Such a medium may take many forms, including but not limitedto, non-volatile media, volatile media, and transmission media.Non-volatile media includes, for example, optical or magnetic disks,such as the storage device 1210. A non-volatile medium is an example ofa non-transitory medium. Volatile media includes dynamic memory, such asthe main memory 1206. A volatile medium is another example of anon-transitory medium. Transmission media includes coaxial cables,copper wire and fiber optics, including the wires that comprise the bus1202. Transmission media can also take the form of acoustic or lightwaves, such as those generated during radio wave and infrared datacommunications.

Common forms of computer-readable media include, for example, a floppydisk, a flexible disk, hard disk, magnetic tape, or any other magneticmedium, a CD-ROM, any other optical medium, punch cards, paper tape, anyother physical medium with patterns of holes, a RAM, a PROM, and EPROM,a FLASH-EPROM, any other memory chip or cartridge, a carrier wave asdescribed hereinafter, or any other medium from which a computer canread.

Various forms of computer-readable media may be involved in carrying oneor more sequences of one or more instructions to the processor 1204 forexecution. For example, the instructions may initially be carried on amagnetic disk of a remote computer. The remote computer can load theinstructions into its dynamic memory and send the instructions over atelephone line using a modem. A modem local to the computer system 1200can receive the data on the telephone line and use an infraredtransmitter to convert the data to an infrared signal. An infrareddetector coupled to the bus 1202 can receive the data carried in theinfrared signal and place the data on the bus 1202. The bus 1202 carriesthe data to the main memory 1206, from which the processor 1204retrieves and executes the instructions. The instructions received bythe main memory 1206 may optionally be stored on the storage device 1210either before or after execution by the processor 1204.

The computer system 1200 also includes a communication interface 1218coupled to the bus 1202. The communication interface 1218 provides atwo-way data communication coupling to a network link 1220 that isconnected to a local network 1222. For example, the communicationinterface 1218 may be an integrated services digital network (ISDN) cardor a modem to provide a data communication connection to a correspondingtype of telephone line. As another example, the communication interface1218 may be a local area network (LAN) card to provide a datacommunication connection to a compatible LAN. Wireless links may also beimplemented. In any such implementation, the communication interface1218 sends and receives electrical, electromagnetic or optical signalsthat carry data streams representing various types of information.

The network link 1220 typically provides data communication through oneor more networks to other devices. For example, the network link 1220may provide a connection through local network 1222 to a host computer1224 or to equipment 1226 such as a radiation beam source or a switchoperatively coupled to a radiation beam source. The data streamstransported over the network link 1220 can comprise electrical,electromagnetic or optical signals. The signals through the variousnetworks and the signals on the network link 1220 and through thecommunication interface 1218, which carry data to and from the computersystem 1200, are exemplary forms of carrier waves transporting theinformation. The computer system 1200 can send messages and receivedata, including program code, through the network(s), the network link1220, and the communication interface 1218.

Although particular embodiments have been shown and described, it willbe understood that they are not intended to limit the presentinventions, and it will be obvious to those skilled in the art thatvarious changes and modifications may be made without departing from thespirit and scope of the present inventions. The specification anddrawings are, accordingly, to be regarded in an illustrative rather thanrestrictive sense. The present inventions are intended to coveralternatives, modifications, and equivalents, which may be includedwithin the spirit and scope of the present inventions as defined by theclaims.

What is claimed:
 1. A medical system, comprising: a positioner; and apatient support coupled to the positioner; wherein the positioner isconfigured to move the patient support in a first path in correspondencewith a movement of a radiation source; wherein the patient support andthe radiation source are configured to move in correspondence with eachother so that the patient support and the radiation source are onopposite sides of a spatial region at a first time instance, and are onother opposite sides of the spatial region at a second time instance. 2.The medical system of claim 1, further comprising the radiation source,wherein the patient support is located at an operative position relativeto the radiation source.
 3. The medical system of claim 2, wherein theradiation source is configured to move along a second path, at least apart of the first path and at least a part of the second path lie withina vertical plane.
 4. The medical system of claim 2, wherein theradiation source is configured to deliver protons, photons, orelectrons.
 5. The medical system of claim 1, wherein the positioner isconfigured to move the patient support along a path having a verticalcomponent.
 6. The medical system of claim 1, further comprising theradiation source and an arm that is rotatably mounted to a structure,wherein the radiation source is coupled to the arm.
 7. The medicalsystem of claim 1, wherein the first path has a non-circular shape. 8.The medical system of claim 1, wherein the first path has a stepconfiguration.
 9. A medical system, comprising: a positioner; a patientsupport coupled to the positioner; and a radiation source; wherein thepositioner is configured to move the patient support in a first path incorrespondence with a movement of a radiation source; wherein thepatient support is located at an operative position relative to theradiation source; and wherein the patient support and the radiationsource is rotatable about a same axis.
 10. The medical system of claim9, wherein the patient support is spaced away from the axis.
 11. Amedical system, comprising: a positioner; and a patient support coupledto the positioner; wherein the positioner is configured to move thepatient support in a first path in correspondence with a movement of aradiation source; wherein the positioner is configured for translatingthe patient support back and forth along an axis; and wherein thepositioner is further configured for translating the patient supportback and forth along an additional axis, wherein the translation of thepatient support along the axis and the translation of the patientsupport along the additional axis are synchronized to cause the patientsupport to move at least partially around a spatial region.
 12. Atreatment planning method, comprising: obtaining one or more firstparameters regarding a positioning of a patient support; obtaining oneor more second parameters regarding a positioning of a radiation source;processing, using a processing unit, the one or more first parametersregarding the positioning of the patient support and the one or moresecond parameters to obtain a treatment plan for processing by atreatment system; and storing the treatment plan in a non-transitorymedium; wherein the treatment plan, when processed by the treatmentsystem, is configured to cause the patient support and the radiationsource to move in correspondence with each other; and wherein thetreatment plan, when processed by the treatment system, is configured tocause the patient support and the radiation source to movecircumferentially around a same spatial region.
 13. The treatmentplanning method of claim 12, wherein the treatment plan, when processedby the treatment system, is configured to cause the patient support totranslate rectilinearly.
 14. The treatment planning method of claim 12,wherein the treatment plan, when processed by the treatment system, isconfigured to cause the patient support to move along a path having avertical component.
 15. The treatment planning method of claim 12,wherein the treatment plan, when processed by the treatment system, isconfigured to cause the patient support to move in a step configuration.16. The treatment planning method of claim 12, wherein the treatmentplan, when processed by the treatment system, is configured to cause thepatient support and the radiation source to move in synchronization witheach other.
 17. The treatment planning method of claim 12, wherein theone or more first parameters prescribe a first couch position for thepatient support, and the one or more second parameters prescribe a firstgantry position for the radiation source that corresponds with the firstcouch position.
 18. The treatment planning method of claim 17, whereinthe one or more first parameters also prescribe a second couch positionfor the patient support, and the one or more second parameters alsoprescribe a second gantry position for the radiation source thatcorresponds with the second couch position.
 19. The treatment planningmethod of claim 18, wherein the one or more first parameters alsoprescribe a position of the patient support be interpolated between thefirst couch position and the second couch position.
 20. A treatmentplanning method, comprising: obtaining one or more first parametersregarding a positioning of a patient support; obtaining one or moresecond parameters regarding a positioning of a radiation source;processing, using a processing unit, the one or more first parametersregarding the positioning of the patient support and the one or moresecond parameters to obtain a treatment plan for processing by atreatment system; and storing the treatment plan in a non-transitorymedium; wherein the treatment plan, when processed by the treatmentsystem, is configured to cause the patient support and the radiationsource to move in correspondence with each other; and wherein thetreatment plan, when processed by the treatment system, is configured tocause the patient support and the radiation source to move incorrespondence with each other so that the patient support and theradiation source are on opposite sides of a spatial region at a firsttime instance, and are on other opposite sides of the spatial region ata second time instance.